What Medical Tests One Should Do Regularly

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Ginny Messina on The Voracious (Ex-)Vegan

Vegan Protein Needs: Updated

What Should I Be Tested For?

I am regularly asked by vegans what they should be tested for. Here is a run down:

Vitamin B12

As I say in Should I Get My B12 Status Tested? -

Vegans do not need to get their homocysteine or B12 levels checked merely because they are vegan. Rather,being vegan means that you should get a regular, reliable source of vitamin B12 from fortified foods and/or

supplements. (Though if youve gone a month or so without a reliable source of B12, you should replenishyour stores as described in Step 1 of the Recommendations.)

About 2% of people do not absorb B12 well. While this has nothing to do with being vegan, it is nice to knowif you are such a person. You will not be able to tell unless you first have a reliable source of B12 for at least

a few weeks before your B12 level is checked. Additionally, there are specific tests that directly measure B12

absorption.

If you get your B12 level checked, please note that eating seaweeds can falsely inflate B12 levels. Methods

for determining B12 levels do not distinguish between B12 and some inactive B12 analogues. Manyseaweeds contain a variety of inactive B12 analogues. Someone who is eating large amounts of seaweed may

have serum B12 levels well above normal, but much of it could be inactive B12 analogues.

Vitamin D

This is probably the one nutrient that vegans really can benefit from getting tested even if they do not haveany symptoms of poor health.

Calcium

The body keeps blood calcium levels relatively constant regardless of your diet, so getting calcium levelstested doesnt tell you much of anything (other than that you are not seriously ill). Getting your bone mineral

density tested is the best way to find out what shape your bones are in. I dont necessarily recommend this,

unless you have reason to believe you might have osteoporosis. Ive said it many times before, but Ill say itagain most vegans should drink calcium-fortified non-dairy milks (or other foods) or take a calcium

supplement.

Omega-3s

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If you are taking a DHA supplement, then you are probably fine. If you are not and want to see what your

DHA levels are, here are some testing places.

There is a more common test that could shed some light on your EPA status blood clotting time. Most

doctors test for this routinely. If your blood is clotting too fast, you might be lacking EPA. But, I rarely hearfrom a vegan whose blood is clotting too fast. If blood clotting time is normal, it doesnt necessarily mean

you have enough DHA.

Iron

If a doctor is going to draw blood, getting an iron panel to see if you have enough (or too much) iron is a goodidea, especially for menstruating women.

Iodine

There is no direct test for iodine. Like B12, its best to just make sure youre getting enough (but not toomuch). Iodine deficiency (and excess) can lead to thyroid problems, so getting your thyroid tested would be

an indirect indicator. Click here for more on iodine.

And that covers it for any routine nutrients to test for regarding the vegan diet.

This entry was posted on Tuesday, November 30th, 2010 at 1:02 pm and is filed underBones, Calcium, Iron, Omega-3s, Testing forNutrient Deficiencies, Vitamin B12. You can follow any responses to this entry through the RSS 2.0 feed. You can skip to the endand leave a response. Pinging is currently not allowed.

28 Responses to What Should I Be Tested For?

1. Colinski Says:November 30th, 2010 at 1:40 pm

Hi Jack, while youre on the subject of D and Calcium, have you seen the stuff all over the news in the

past day about new research challenging conventional wisdom in regard to supplementing those two

things?http://www.nytimes.com/2010/11/30/health/30vitamin.html

Any thoughts?

2. Jack Norris RD Says:November 30th, 2010 at 1:47 pm

Colinski,

I will post about that as soon as I get a chance.

3. Putting the Late in Deflate Pythagorean CrankSays:November 30th, 2010 at 3:31 pm

[...] As the accounts of ex-vegans continue to pile up vegans are wiping the Ener-G from their face and

scrambling to plug the nutrition gaps in the ill-advised health vegans knowledge. This may stem the

eventual [...]

4. Joselle Says:November 30th, 2010 at 6:41 pm




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Prior to going vegan (but in the early stages of me being vegetarian and soon after vegan), my b12 levels

were well above normal. Just a year laterand after a year of being veganmy B12 levels dropped fromthe 600 range to the 300 range. While this is still clinically considered normal, Sally M. Pacholok, RN,

who coauthored the book, Could It Be B12 (http://b12awareness.org/) says anything below 400 should

be considered a deficiency or at least the start of one. My homocysteine and methylmalonic acid levelswere within normal ranges but this seemingly (at least to me) drastic drop in my B12 levels concerns

me. I always took and continue to take a reliable source of supplemented B12 in the form of a

multivitamin so it wasnt that I wasnt supplementing. I take a vegan multivitamin that has 25 mcg(313% of DV) of B12 as cyancobalamin. Pacholok argues this is not the most readily absorbable form

(she recommends methylcobalamin instead) but its the one I always heard vegan nutriton sourcesendorsing. Whats your take on that?

The last time I had my levels checked was in 2008. Im going to go to my PCP soon to get it recheckedand go from there. Im not a dietician or healthcare professional but I am currently a pre-nursing student

with plans of being a nurse-midwife, so Im studying anatomy and physio and nutrition right now. It

does seem that in my case, my being veganand not just B12 absorption or lack of supplementationhadplenty to do with my B12 levels.

I am still vegan and have been for nearly three years but I have been thinking about whether thats

something Ill do long term given my last B12 results. Of course, if I can take different supplements,higher doses, a different form of B12, or shots and stay vegan, I would prefer it. Its also possible that

my B12 levels will be fine this next time around. Thats why I havent decided to stop practicingveganism without more current bloodwork. But its definitely something Ive reconsidered since

learning Pacholoks perspective on B12 and relooking at my results.

Ive also spread the word to my mom since shes over 50 and B12 absorption, as you well know, is not

just a vegan concern but is also one for those of us getting older.

Would love to hear what you think about this. Thanks for the helpful info on this site. BTW, my vitamin

D levels were great!


Joselle,

If you take a chewable B12 supplement of 1,000 g, twice a week, your B12 levels should be fine. Iwould disagree that there is any case for alarm that they dropped to 300. By the way, do you know the

units they were measured in each time, and the units Pacholok recommends? B12 is typically measuredin both pg/ml as well as pmol/l.

1 pg/ml = 1.35 pmol/l

If your homocysteine and MMA levels were fine, then there is really nothing to worry about as long asyou up the B12 a bit. B12 from chewable supplements is much more easily absorbed than from animalproducts.


Hi Jack,

The units were pg/mL. Im not sure off the top of my head what units Pacholok recommends.




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I bought a chewable form of B12 but havent taken it yet because Pacholok recommended getting tested

before tinkering around. I am going to get tested again and then go from there. For now, Im still justtaking my multi.


Joselle,

I wouldnt put too much faith in Pacholok. Ive never seen any peer-reviewed research indicating that

someone shouldnt tinker around with their B12 levels. Oh, I forgot to give you the link to themethylcobalamin information:

http://veganhealth.org/b12/noncyanob12


Hi Jack,

Perhaps I phrased that wrong. She did not say that someone shouldnt take B12 supplements or tinker

around with doses. What she said is not to assume you have a deficiency without a test and then just take

megadoses because you self-diagnosed. And, if you do suspect a deficiency, to not take megadosesbefore your test and perhaps skew results. She had pernicious anemia, has been an RN for many years

and has studied B12. She was and is not vegan but doesnt seem antivegan at alljust pro-awareness. In

fact, Id say shes mostly preaching to nonvegans, especially since were more aware of B12 than youraverage nonvegan. Much of what she says seems sound. I figured another few weeks without chewables

until I test again wouldnt hurt since Ive gone years without them.

My recent little, little doubts of veganism hasnt been just her work but also my current schooling and

perhaps some paranoia from too much reading! Im just thinking and havent written off my 3-year,

very heartfelt commitment to veganism by any stretch of the imagination.

Thanks for your time and help with this. Ill check out that link.

9. SaywardSays:November 30th, 2010 at 10:35 pm

Joselle! So funny, I was reading this article and thinking of your email, then scrolled down to the

comments and there you were. =D

Hi!

10. Laura Says:December 1st, 2010 at 6:01 am

Can people be wiped out or brain fogged from iron deficiency, with low-normal hemoglobin? Myhemoglobin was 12.3 g/dl, my hematocrit was 36.7% and my RBCs were 4.01.

11. Lisa A. Says:December 1st, 2010 at 9:30 pm




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Jack,

Do you consider zink to be an important mineral to be tested for? I had a low borderline reading when I

checked last month. Although my husband had a level in the middle of the normal range.

I also wanted to ask you about the lastest vitamin D and calcium report. I am looking forward to reading

your post on that topic.

12. Jack Norris RD Says:December 2nd, 2010 at 9:58 am

Lisa,

Plasma zinc is similar to calcium, unless you are severely deficient, it does not tell you much. There aremany other ways to measure zinc, but the last I knew, none seemed to be considered reliable for

determining the adequacy of someones zinc status. How were yours tested?

13. Lisa A. Says:December 3rd, 2010 at 7:01 am

Jack,

I had my blood checked by Kaiser. Here are the results:Zink -Your value: 61 Normal Range: 60-130 mcg/dL

Why is this not reliable? Can you recommend a website that has information about zink. I noticed thatveganhealth.org has very little information about this mineral.

14. Jack Norris RD Says:December 3rd, 2010 at 4:28 pm

Lisa A,

I just meant that your blood zinc level will not tell you if you are getting enough in your diet (and in

your cells). As I explained above, its because the body keep the zinc levels in the blood fairly stableexcept in extreme situations. I would not consider a finding on the low end of normal to be indicative

that you have a problem, but you could always take a modest zinc supplement for insurance.

15. La Donna FSays:December 10th, 2010 at 9:24 am

I followed the link to the iodine article and read it. I have a bottle of potassium iodide that says each pill

contains 32.5 mg. Of potassium iodide and the article recommends a daily dose in terms of mcgamounts. I am not familiar with mcg. How often can I take these pills to keep my levels of iodine up? Ialso use iodized salt and live in the Midwest.

16. Jack Norris RD Says:December 14th, 2010 at 3:36 pm

La Donna F,




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There is 1,000 mcg in a mg. Do not take potassium iodide for meeting iodine requirements as it is way

too much iodine. Here is more information:

http://www.bt.cdc.gov/radiation/ki.asp

If you use iodized salt, you should be fine.

17. Lisa A. Says:May 16th, 2011 at 7:00 pm

Hi Jack!

I decided to translate this post and include it on the website because so many people have asked me

about this. I was wondering if you could include a note about testing ones level of protein. I have heardsomeone mention that they did that. Although, I have never done it myself. Do you know anything about

how such testing works?

Also, maybe you could also include a brief note about zinc in your post. It seems to be a nutrient of

concern in vegan diets and some people might be wondering about how they can check their level. At

least it will be helpful for them to have some understanding about this.

Thanks for your time!

Lisa A.

18. Jack Norris RD Says:August 24th, 2011 at 10:38 am

Lisa,

Its been a long time since you submitted that comment. Im sorry it took me so long to put it through.

Regarding testing for protein, there isnt anything that is going to detect a mild deficiency, unless youhave a nitrogen balance study done on yourself and that is pretty impractical. If you have fairly serious

protein deficiency, then your blood albumin and prealbumin levels could tell you about long and short-

term deficiency, respectively.

As for zinc, as Ive said elsewhere, there isnt a good test for mild zinc deficiency. But if you are gettinglots of colds, it might be something to consider. In recent years, I have been taking a calcium

supplement that contains magnesium and zinc to make sure Im getting enough. Probably not a bad idea

for all vegans.

The Linus Pauling Institute has a pretty good page on zinc here.

19. MarekSays:September 16th, 2012 at 11:47 am

My doctor has suggested measuring serum PTH as an indicator of whether one has enough calcium.What do you think of that?

20. Jack Norris RD Says:September 16th, 2012 at 10:31 pm

Marek,




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I think it could shed some light on the situation, but cannot tell the entire story.

21. MarekSays:October 10th, 2012 at 4:10 am

Jack, why do you think it cant tell the entire story? Is it because it can only show if there has beenenough calcium in the diet recently, but not in the long-term?

One hospital in Prague has recently opened some sort of nutritional advice bureau, where thorough

blood tests are offered, the doctor there said to me yesterday that he has so far examined over 30 vegans

and that an increased PTH is quite common among them. But I also know vegans whove been there andhad normal PTH level even though they dont try to include calcium-rich foods (so Id guess their intake

will be about 500 mg or below). So does it mean that some people are doing just fine on low calcium

intakes and that the much higher recommendation is only made because some people need more? Or arethere still reasons to worry even if PTH is consistently normal on low intake?

22. Jack Norris RD Says:October 10th, 2012 at 4:41 pm

Marek,

> Is it because it can only show if there has been enough calcium in the diet recently, but not in the long-

term?

That would be one thing to consider. But I was mostly thinking about the fact that vitamin D status can

affect PTH levels. There are other things that can also (kidney disease and other diseases), but thoseshould be minor issues in a typical sample of vegans.

23. Jill Princehouse Says:October 20th, 2012 at 5:02 pm

Are there changes in CBC or other blood tests that indicate better health on a vegan diet (but worsehealth on a standard American diet?


Jill,

I dont understand your question.

25. Jill Princehouse Says:October 20th, 2012 at 8:49 pm

Joel Fuhrman says a CBC with a wbc count in the 2s indicates health. What about other CBC values? Isit healthy if they are low by typical standards too?


Jill,




8/12

I have no reason to think that any abnormal values in a CBC count would mean something different for

someone on a vegan diet than for someone on a non-vegan diet.

27. MarekSays:June 1st, 2013 at 12:27 pm

Jack, Ive recently come back to this question while preparing a lecture about vegan myths: Is there any

reason why someone with a low calcium intake but normal serum PTH and Ca levels should stillincrease their calcium intake?

I know quite a few vegans who dont eat any calcium supplements, calcium-fortified foods or highcalcium greens (so I assume their daily intake could be around 300-500 mg per day) but have normal

blood Ca and PTH levels. I understand this doesnt mean that everyone can do well on such low intakes,

but it makes me much less convinced than I used to be about encouraging all vegans to increase calciumconsumption to 700 mg per day especially since I feel a certain risk that it might do more harm than

good in some cases (e.g. by possibly decreasing iron absorption). There are some practical reasons as

well we dont have that many calcium fortified food and high-calcium greens in Central Europe.

So I wonder whether regular checks for blood PTH and Ca levels first might actually be a better option

or at least a good alternative to preventively struggling for 700 mg calcium per day.

What do you think?

28. Jack Norris RD Says:June 1st, 2013 at 1:18 pm

Marek,

Good question. I searched for about 30 minutes online and couldnt find anything that really addressesthis question. I would feel more comfortable talking to someone who is an osteoprosis expert. Im knee

deep in other issues right now, but will try to get to this soon. If, in the meantime, you might want to

write some osteoporosis experts at a University or a foundation you might be able to get an answer morequickly.

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What Medical Tests One Should Do Regularly